Provider Demographics
NPI:1669168720
Name:POULAKOS, HOPE LOPRESTI (AGNP)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:LOPRESTI
Last Name:POULAKOS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 SUMMERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1593
Mailing Address - Country:US
Mailing Address - Phone:908-309-0226
Mailing Address - Fax:
Practice Address - Street 1:2191 DEFENSE HWY
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2931
Practice Address - Country:US
Practice Address - Phone:410-451-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR251534363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology